Marketing Analysis: Antiemetic Drugs on the Pharmaceutical Market of Uzbekistan

In this study, we analysed, with the help of the “State Register of Medicines, Medical Devices and Medical Equipment Permitted for Use in Medical Practice of the Republic of Uzbekistan”, the number, dosage forms and cost of registered antiemetic drugs in 2016-2020 based on the DRUG AUDIT program, which offers a database of information from 2016 to 2020.


Introduction
According to Article 4 of Law No. LRU-399 of the Republic of Uzbekistan, dated January 4, 2016, "On Medicines and Pharmaceutical Activities", the state guarantees the availability of essential medicines as well as medical devices and their quality, includes antiemetic drugs in the list of essential medicines in the Republic of Uzbekistan and notes that their production and availability at accessible prices are especially important for the country's population [4,12,13].
In accordance with Decree No. -5229 of the President of the Republic of Uzbekistan, dated November 7, 2017, "On Measures to Radically Improve the Pharmaceutical Industry Management System", to improve conditions for the development of pharmaceutical activities, increase the provision of affordable, highquality medicines, medical products and medical equipment for the population and health care institutions, and introduce a uni ed coordination system for the production, import and sale of these items, a market analysis was carried out [11,14].
Antiemetic drugs can treat conditions such as nausea and vomiting that commonly occur with other drugs, such as drugs given for anaesthesia during surgery or chemotherapy for cancer. They can also be used independently to treat vomiting caused by several medical conditions, including chemotherapy, motion sickness, gastroenteritis, general anaesthetics, opioid analgesics, dizziness, pregnancy, food poisoning, emotional stress, and others. Chemotherapy is leading segment of use, as the number of cancer patients is increasing daily. In the case of pregnant women, these drugs bring signi cant relief to women suffering from morning sickness or nausea in early pregnancy. For some women, morning sickness lasts much longer, and antiemetic drugs are extremely helpful in these situations. Antiemetic drugs are usually taken by the mouth and sometimes by injection [1,2,8,9,[15][16][17][18].
Demand for antiemetic drugs is mainly fuelled by the rapidly growing geriatric population around the world, which is highly susceptible to diseases such as cancer that are mostly treated with chemotherapy, leading to side effects such as vomiting. In addition, the growing number of patients with gastroenteritis also contributes to the increase in demand [1, 2, 6-9, 19, 20].
The market for antiemetics, which has shown strong growth thus far, is likely to expand further, albeit at a slow pace, in the coming years due to the drying up of clinical supplies. The cost of research and development is high, which holds back the development of new drugs. As a result, many experienced companies are carefully considering the possibility of new research projects in the eld of molecules or drugs [1,6,7].
Purpose of the study. To further improve the provision of the population with high-quality, effective and safe pharmaceutical products, expand production volumes, increase the scienti c, technical and export potential of domestic manufacturers, and attract foreign direct investment, a ve-year analysis was carried out to accompany further plans to improve the identi ed situation [3].
This article analyses the number of packages and costs associated with the production of domestic products and the supply of antiemetic drugs from CIS and foreign countries to the pharmaceutical market of the Republic of Uzbekistan.

Materials And Methods
To carry out this analysis, we used the data provided in the "State Register of Medicines, Medical Devices As can be seen from the data in Table 1, the share number of antiemetic drugs produced in the CIS countries accounteds for from 73,851 to 259,458 the number of imports at its peak in 2017 but, which by 2020 had decreased to 73,851, the. The share of Fforeign manufacturesmanufacturers of antiemetic drugs accounted for from 92,841 to 266,363 imports, which peaking in 2018 at was almost more than 2 times moretwice the number in each of the two previous years. The share number from of domestic producers, in contrast to the numbers the from CIS and foreign suppliers, was signi cantly increased from 144,372 to 876,989 (2017) (Fig. 1). During the study period, the volume of imports of antiemetic drugs from the CIS countries increased by 3.5 times, that from foreign countries by 2.9 times, and that from domestic manufacturers by 6 times.
The results show that antiemetic drugs in all dosage forms and registered and produced by domestic manufacturers for the ve years account for an average of 62% of the total, with the remaining 38% (20% of the production of CIS countries and 18% of foreign countries) imported into the country for consumption for foreign currency accounts (Fig. 2). Table 2 shows the numbers of antiemetic drugs in the form of tablets registered in the Republic of Uzbekistan for 2016-2020. Among the total imports of antiemetic drugs, the production of CIS countries began at 76211 and peaked at 202358 imports but by 2020 had decreased to 73851. The number from foreign manufacturers of antiemetic drugs ranges from 3300 to 35316 imports, with no imports in 2016. The number of domestically produced antiemetic drugs ranges from 24500 to 67689, but this drug was not domestically produced in the form of tablets over the last 3 years. The numbers of antiemetic drugs in the form of ampoules registered in the Republic of Uzbekistan for 2016-2020 are shown in Table 3. Within this category of antiemetic drugs, there were no imports from CIS countries and no production by domestic manufacturers, and foreign produced antiemetic drugs accounted for 12,065 to 25,740 imports, with no imports in 2017 or 2019.   Regarding the number of antiemetic drugs in the form of solution ampoules registered in the Republic of Uzbekistan for 2016-2020, information on the total imports of antiemetic drugs and the number produced by CIS countries and domestic manufacturers was not available; for foreign manufacturers, there were no imports from 2016 to 2019, while in 2020, 10,731 drugs were imported (Table 5).  The aim of this work was to study the domestic production of different dosage forms of antiemetic drugs registered in the Republic of Uzbekistan, depending on their manufacturers [11].
As seen from the data in Table 6, the analysis of domestically produced dosage forms of antiemetic drugs, based on information from the DRUG AUDIT program for 2016-2020, shows that 2,602,720 packages were produced by local manufacturers; of this total, a signi cant number were produced by Merrimed Farm, Uzbekistan (2,010,770 packages or 77%), all of them preparations in the form of solutions.  Figure 3 shows the numbers of domestically produced antiemetic drugs produced in various dosage forms. As seen from Figure 3, a total of 2,602,720 packages were produced, of which 92,189 packages were in the form of tablets, 2,510,531 in the form of solutions, and none in the form of ampoules or ampoule solutions.
As seen from the data in Table 7, the analysis of dosage forms of antiemetic drugs produced in CIS countries, according to the DRUG AUDIT program for 2016-2020, shows that 2,602,720 packages were imported from manufacturers in CIS countries; a signi cant number of this total were produced by Borisovskiy, Belarus (659,609 packages or 97%), in the form of tablets and solutions.    Regarding the prices of antiemetic drugs produced by domestic manufacturers in 2016-2020, the value for tablets amounted to 93,249 USD and for solutions to 1,478,945 USD, while ampoules and solution ampoules were not produced (Table 9) [2].   A comparison of the prices for 2016-2020 of medicines produced by domestic manufacturers and manufacturers in CIS and foreign countries registered in the Republic of Uzbekistan can be seen in Figure  7.

Conclusion
This analysis of the dosage forms, volume of imports, prices and number of registered antiemetic drugs for the period from 2016 to 2020 shows that antiemetic drugs in dosage forms such as gel, drops, capsules, ointments, suppositories and suspensions have not yet been imported or manufactured by domestic manufacturers. Tablets, ampoules and solution ampoules are smaller and are the primary dosage form registered in the Republic of Uzbekistan. Today, demand for tablet and solution dosage forms among the population remains important for our further research and for the choice of which drug forms to import.
Antiemetic drugs are produced in su cient quantities in the form of solutions, but the price of imported products from foreign countries is quite expensive. This shows that it is necessary to pay great attention to the production of domestic drugs that are not inferior to those produced by foreign manufacturersboth in terms of prices and the availability of dosage forms.
Considering that the share of antiemetic drugs in the form of solutions is signi cant in comparison to the shares of other dosage forms, we consider it expedient to produce this drug form on the basis of demand from the population of the Republic of Uzbekistan.
Declarations 20. Leung A.K., Robson W.L. Acute gastroenteritis in children: role of antiemetic medication for gastroenteritis-related vomiting. Paediatr Drugs. 2007;9(3):175-184. Figure 1 The volume of imports of all registered dosage forms of antiemetic drugs from domestic, CIS and foreign manufacturers to the Republic of Uzbekistan Number of antiemetic drugs produced in foreign countries, and produced in various dosage forms Cost of medicines registered in the Republic of Uzbekistan (2016-2020) from domestic manufacturers and manufacturers in CIS and foreign countries